Pediatric emergency department utilisation during Ramadan: a retrospective cross-sectional study

OBJECTIVE

To investigate the impact of Ramadan on patient characteristics, diagnoses and metrics in the paediatric emergency department (PED).

DESIGN

Retrospective cross-sectional study.

SETTING

PED of a tertiary care centre in Lebanon.

PATIENTS

All paediatric patients.

EXPOSURE

Ramadan (June 2016 and 2017) versus the months before and after Ramadan (non-Ramadan).

MAIN OUTCOME MEASURES

Patient and illness characteristics and PED metrics including peak patient load; presentation timings; length of stay; and times to order tests, receive samples and report results.

RESULTS

We included 5711 patients with mean age of 6.1±5.3 years and 55.4% males. The number of daily visits was 28.3±6.5 during Ramadan versus 31.5±7.3 during non-Ramadan (p=0.004). The peak time of visits ranged from 18:00 to 22:00 during non-Ramadan versus from 22:00 to 02:00 during Ramadan. During Ramadan, there were significantly more gastrointestinal (GI) and trauma-related complaints (39.0% vs 35.4%, p=0.01 and 2.9% vs 1.8%, p=0.005). The Ramadan group had faster work efficiency measures such as times to order tests (21.1±21.3 vs 24.3±28.1 min, p<0.0001) and to collect samples (50.7±44.5 vs 54.8±42.6 min, p=0.03).

CONCLUSIONS

Ramadan changes presentation patterns, with fewer daily visits and a later peak time of visits. Ramadan also affects illness presentation patterns with more GI and trauma cases. Fasting times during Ramadan did not affect staff work efficiency. These findings could help EDs structure their staffing to optimise resource allocation during Ramadan.

Factors Associated with Survival After Emergency Department Thoracotomy for Adult Trauma Patients in the United States

BACKGROUND

Emergency department thoracotomy (EDT) is done to control life threatening hemorrhage and injuries. Literature examining this topic is limited to relatively small studies from single trauma centers.

OBJECTIVE

This study identifies factors associated with survival to hospital discharge of patients undergoing EDT using the largest U.S. national trauma database.

METHODS

This retrospective cohort study used the U.S. National Trauma Data Bank 2015. We conducted univariate and bivariate analyses followed by a multivariate analysis that adjusted for confounders to identify factors associated with survival.

RESULTS

Two thousand four hundred eighty-six patients who underwent EDT were included. Most patients were 16 to 64 years of age (92.3%) with a male predominance (84.9%) and without any previous comorbidities (62.8%). Penetrating injury was most common (60.2%), mainly as a result of assault (51.0%) by firearm (45.1%). Overall survival to hospital discharge was 38.2%. After adjusting for confounders, factors associated with increased survival were cut/piece injuries, presenting with signs of life, Glasgow Coma Scale score ≥8, systolic blood pressure >90 mm Hg, and transportation to the ED through helicopter/fixed-wing ambulance or public/private vehicle (reference, ground ambulance).

CONCLUSIONS

Factors associated with survival in patients undergoing EDT were identified. The clinical indication of presence of appropriate resources to continue and repair EDT was validated, along with the contraindications of lack of signs of life and presence of major nonsurvivable injuries. Future studies should focus on validation of all criteria of EDT, namely hemodynamic instability despite appropriate fluid resuscitation, duration of time of cardiopulmonary resuscitation and pulselessness, cardiac rhythm on arrival, and the presence of pericardial tamponade.

Impact of trauma designation levels on survival of drowning victims: An observational study from trauma centers in the United States

Drowning causes significant morbidity and mortality. Healthcare regionalization aims at improving patient outcomes. This study examines the impact of trauma center level designation on survival of drowning victims.Retrospective cohort study utilizing the National Trauma Data Bank (NTDB) 2015. Descriptive, bivariate and multivariate analyses were conducted.The 212 patients were included. Mean age was 33.58 (±20.02) years with 69.3% (n = 147) males. Patients were mostly taken to Level I (n = 107, 50.5%) and II (n = 81, 32.8%) centers, requiring admission (43.5% (n = 96), 23.1% (n = 49) and 8.5% (n = 18) to Intensive Care, floor, and Operating Room, respectively). Overall hospital discharge survival was 83.5% (n = 177). After adjusting for confounders, there was no significant difference in survival of patients taken to Level I compared to Level II and III centers.This study did not identify a survival benefit for patients with drowning related injuries when taken to Level I compared to Level II or III Trauma centers. Further outcome studies are needed in organized trauma systems to improve field triage criteria for specific injury mechanisms.

Impact of trauma level designation on survival of patients arriving with no signs of life to US trauma centers

BACKGROUND

Trauma level designation and verification are examples of healthcare regionalization aiming at improving patient outcomes. This study examines impact of Trauma Levels on survival of patients arriving with "no signs of life" to US trauma centers.

METHODS

This retrospective study used the US National Trauma Data Bank (NTDB) 2015 dataset. A descriptive followed by a bivariate analysis was done comparing variables by the trauma designation levels. A multivariate analysis assessed the effect of the trauma designation on survival to hospital discharge after controlling for potential confounding factors.

RESULTS

6160 patients without signs of life were included. The average age was 40.66 years (±19.96) with male predominance (77.3%). Most patients were transported using ground ambulance (83.5%) and were taken to Level I (57%) and Level II (32.4%) centers. Blunt injuries were the most common (56.9%). Motor Vehicle Collision (MVC) (38.5%) and firearm (33.8%) were the most common mechanisms of injury. Survival to hospital discharge among patients with no signs of life ranged from 13.7% at Level I to 27.9% at Level III. After adjusting for confounders, including Injury Severity Score (ISS), higher survival was noted at Level II trauma centers compared to Level I.

CONCLUSIONS

Patients presenting without signs of life to Level II trauma centers had higher survival to hospital discharge compared to Level I and Level III centers. These findings can guide future prehospital triage criteria of trauma patients in organized Emergency Medical Services (EMS) systems and highlight the need for more outcome research on trauma systems.